Lewandowski Daniel A, Hussain Adnan, Chun Charki, Chiang Lynden, Ahuja Sashin
Trauma and Orthopaedics, Univeristy Hospital of Wales, Cardiff, GBR.
Trauma and Orthopaedics, University Hospital of Wales, Cardiff, GBR.
Cureus. 2024 Sep 11;16(9):e69154. doi: 10.7759/cureus.69154. eCollection 2024 Sep.
Introduction Laminar flow (LF) in theatres has become the standard of care in orthopaedic implant surgery. Most of the evidence for laminar flow use is based on arthroplasty surgery, with early studies showing a significant reduction in infections. We conducted a retrospective comparative study to assess surgical site infection (SSI) rates in consecutive patients undergoing surgery for trauma in LF and non-laminar flow (NLF) theatres. Methods Due to COVID-19 safety restrictions, trauma surgery was performed in non-laminar flow theatres during the pandemic. We identified consecutive patients who had trauma surgery pre- and post-pandemic from February 2019 to June 2021 to avoid selection bias. A total of 1809 patients were identified for the study, and the relevant patient details were collected through the hospital operating theatre software (Bluespier) and patient records (Welsh Clinical Portal). There were 917 in the laminar theatre group and 892 in the non-laminar theatre group. For the purpose of this study, we recorded SSI rates within the first 90 days. The two groups were statistically similar in terms of age and gender of the patients. Results Nineteen patients developed surgical site infections in non-laminar flow theatres and 25 patients in laminar flow theatres. There was no significant difference between the SSI rate in laminar flow theatres (2.72%) as compared to non-laminar flow theatres (2.13%) (p=0.399). There was no link between infections and the duration of surgery. Two patients in the laminar flow group were MRSA-positive and were excluded. Conclusion In our study, the laminar flow theatres did not show a statistically significant reduction in surgical site infections. We conclude in the practical environment of trauma theatres the theoretical advantage of laminar flow does not translate to an observable reduction of infections.
引言 手术室的层流（LF）已成为骨科植入手术的护理标准。大多数关于使用层流的证据都基于关节置换手术，早期研究表明感染率显著降低。我们进行了一项回顾性比较研究，以评估在层流手术室和非层流（NLF）手术室接受创伤手术的连续患者的手术部位感染（SSI）率。
方法 由于COVID-19安全限制，在大流行期间创伤手术在非层流手术室进行。我们确定了2019年2月至2021年6月大流行前后接受创伤手术的连续患者，以避免选择偏倚。共确定1809例患者纳入研究，通过医院手术室软件（Bluespier）和患者记录（威尔士临床门户）收集相关患者详细信息。层流手术室组有917例，非层流手术室组有892例。为了本研究的目的，我们记录了前90天内的SSI率。两组患者在年龄和性别方面在统计学上相似。
结果 非层流手术室有19例患者发生手术部位感染，层流手术室有25例患者发生手术部位感染。层流手术室的SSI率（2.72%）与非层流手术室（2.13%）相比无显著差异（p=0.399）。感染与手术持续时间之间没有关联。层流组有2例患者MRSA呈阳性，被排除在外。
结论 在我们的研究中，层流手术室在手术部位感染方面没有显示出统计学上的显著降低。我们得出结论，在创伤手术室的实际环境中，层流的理论优势并未转化为可观察到的感染减少。
